Thinking of becoming EMT

This is a discussion on Thinking of becoming EMT within the Bob & Terry's Place forums, part of the The Back Porch category; I am considering taking a EMT course and becoming a EMT-B and would like the thoughts of others on what to expect and the field ...

Welcome to EMS
Welcome to EMS. It may not be the highest paying of professions, but you’ll be rewarded in other ways.

Recently, I was asked by a colleague to write an introduction letter for her EMT class. I had read David Givot’s excellent commencement speech for paramedic graduates, and I thought long and hard about what I wish someone had said to me on my first day of EMT class, before I even embarked on this career path. This is my answer.

~ Kelly Grayson, NREMT-P, CCEMT-P

Welcome to the profession whose entry-level practitioners — you, in a few months — rank 4th from the bottom in the Bureau of Labor Statistics salary rankings. The only people paid less than you are pre-school teachers, dishwashers and meatpackers. The guy riding on the back of the garbage truck, or holding a sign at a highway construction zone, makes more money than your EMT instructor. Likely, a lot more.

And none of those people are required to make life-or-death decisions. You will.

It is a profession where the line-of-duty death rate is comparable to firefighters and police officers. For those of you who aspire to flight paramedic status, that particular niche is by far the most dangerous profession in America — ahead of loggers, miners, and Alaska crab fisherman.

It is a profession whose divorce, suicide and substance abuse rates soar far higher than the general population. The average career expectancy of an EMT is five years.

Five years.

Some of you will go on to jobs in nursing or other healthcare fields. Those of you that don’t move on to nursing or PA school will leave EMS with a career-ending back injury, or leave EMS healthy but not whole; jaded and cynical, your idealism burned away in the furnace-like reality of our profession, your faith in the innate goodness of man gone like so much ash and smoke up the chimney.

You’ll be disrespected
You will be disrespected by patients and bystanders who don’t know any better, and belittled by doctors and nurses who should. And many of you will endure the abuse for free labor, donating your services as volunteers.

So why do I tell you this? Well, they call it informed consent, a concept you’ll learn about in the first few chapters of that EMT textbook you’re carrying. Before you agree to the abuse you’re about to suffer, it’s only fair that you know what you’re getting into.

And it’s not what you think.

You will sift through broken glass and twisted metal, wade through urine and feces and vomit, weather heaping torrents of verbal abuse from the people you’re trying to help, all for the prospect of a few dollars on payday, and perhaps…just perhaps…a show of gratitude now and again.

I’m here to tell you that what you’ve been promised is a lie, if only a little white one. When you’re green and idealistic, the romance and thrill of EMS is powerful. All of us were adrenaline junkies at some point. Plus, there’s a decent chance it might even get you laid. What’s not to like?

You won’t save that many lives
But you will soon discover the hidden truth, the one that drives most people out of our profession:

We don’t save that many lives.

Lifesaving may be what we train for, but the opportunity to actually save someone comes all too rarely, and when it does present itself, the outcome depends more upon luck and timing than our skills. In my career, I’ve had my share of code saves. Some of them even made it out of the hospital alive. Others hung on just long enough for their families to tell them goodbye. I’ve made the critical diagnosis, gotten the tough airway, turned around the crashing asthmatic, and stabilized the shocky gangbanger with multiple unnatural holes in his person. I’ve needled chests, paced, defibrillated, and cardioverted, and given countless drugs.

But, other than a handful of exceptions, I can’t state with any certainty that my actions were the difference between life and death. In that handful of exceptions, all but one or two were saved simply by applying the techniques that any John Q. Citizen with a basic first aid course could have done. Ask your instructor if you don’t believe it’s true. They’ll tell you the same thing.

The reality of the profession
The reality of your profession isn’t exciting rescues and cardiac arrest resuscitations twice a shift. Your reality will be dialysis transfers and people who can’t poop. It will be toothaches at 3:00 am, and you’ll have to maneuver your stretcher around five parked cars to get to the front door, and weave your way through five able-bodied drivers to get to the patient with a complaint so minor you can’t believe they called 911 for it.

So why, if you’re not going to save all that many lives, should you even bother?

You should bother because EMS is a calling. Even when you leave EMS, it never really leaves you. It’s what Henry David Thoreau meant when he said, “Do what you love. Know your own bone; gnaw at it, bury it, unearth it, and gnaw it still.”

You should bother because, even if we’re not saving lives, what we do matters. It matters in ways unnoticed by us, to people you may not even remember tomorrow.

You should bother, because EMTs are privileged to play in life’s great game. Too many unlucky people watch the action thunder by, stuck at a desk, or watching it on television at home.

You should bother, because it’s the little things that matter. Most of your patients are ignorant of your skills. Few of them understand the technology you wielded so expertly. But they’ll remember the smile you gave them, or the way you tucked the blanket in to ward away winter’s chill, or the way you stood in the rain, getting drenched as you held the umbrella over them as your partner loaded them in the rig. They’ll remember calm competence, and gentle speech.

They’ll remember the joke you made to lighten the tension. They’ll remember those things and more, and they’ll remember your face long after you’ve forgotten theirs.

You’ll be remembered
They’ll remember you because, even though they were just another call to you, you were a major player in a defining event in their lives. They’ll come up to you, years after the fact, and say, “I remember you. You took care of me when I had my heart attack.”

And likely all you did was apply oxygen and take them to the hospital. Maybe you helped them with another dose of nitro or encouraged them to take an aspirin — really nothing they couldn’t have done themselves. But you’re the one they remembered, and you’re the one they thanked.

You should bother, because in the tapestry of human existence, you get to contribute your own unique stitch. You get to make your mark in ways that cannot be quantified on a spreadsheet or a profit and loss statement. Not everyone gets to touch the life of another, but EMTs do.

You should bother, because when people are at their most vulnerable, they will invite you into their homes and tell you things they won’t even tell their priest. And they’ll expect you to make it better somehow. I’m not sure you understand now how profound an honor that is, but hopefully one day you will.

The question is, can you be worthy of that honor?

If you think so, then welcome to EMS. Do us proud.

I'm a paramedic. It's the best/worst job there is. Personally, I stumbled into this field. I never grew up dreaming of being a paramedic. I'm working on finding work outside of ems. It's been fun, and I'll keep my license, but I'd rather do something else full time.

If you think you'd like it, then go for it. It's a front row seat to the greatest show on earth.

I'm a paramedic. It's the best/worst job there is. Personally, I stumbled into this field. I never grew up dreaming of being a paramedic. I'm working on finding work outside of ems. It's been fun, and I'll keep my license, but I'd rather do something else full time.

If you think you'd like it, then go for it. It's a front row seat to the greatest show on earth.

I have been involved in EMS since 1975 and that is the best description I have ever seen.

A woman must not depend on protection by men. A woman must learn to protect herself.
Susan B. Anthony
A armed society is a polite society. Manners are good when one has to back it up with his life.
Robert Heinlein

Speaking as a Paramedic (and please, realize the difference between EMT and Paramedic):

Do a ride along with your local EMS agency. See what a normal shift is like. See that, if you're lucky, only 20% of 911 calls are legitimate usage of 911 (that goes for fire and PD as well), and only ~10% of the total are actual calls that the normal citizens thinks 911 really is: life and death, major sickness and injury.

If, after the ride along you still think you might want to continue on for you EMT, don't. Do a second ride along because one shift isn't enough to form an opinion. If after the second ride you still want to, get your EMT, and if your EMT class is any good, you'll do a decent amount of time in the hospital and on the ambulance.

If you get your EMT certification, and you still want a job/ career in EMS, go straight on and get your Paramedic, do not stop at EMT.

Prepare to become jaded. I have a friend who works as an EMT in Detroit. His attitude towards human life has changed drastically over years I have known him. To the extent possible I have tried to learn from his experiences but secondhand knowlege is just that. If you feel called to the profession go for it but talk to those already in the field first.

I started acquiring my training and working volunteer (Explorers) in 1976. Got my EMT-B license when I was a senior in high school. I've been in EMS as a full time paid professional since 1979. Thirty years of it as a paramedic (EMT-P). Fifteen of those thirty plus years in the fire service and nine of those years law enforcement swat medic. Almost ten years in a major urban city. I also did a four year stint in the U.S. Marine Corps squeezed in between (I maintained my professional license when I was in the Corps, and worked part time on the local EMS when I was in the Marines).

All I will say is do not to get into EMS without a plan for steering your career in a direction you want to go and have options for an early out. Make some goals as to where you want to be in five years, fifteen years, twenty years, etc.

Be prepared to be permanently disabled at anytime. That disability may allow you to go into another occupation all together, or you may end up being unable to work doing anything and living the rest of your life in chronic pain.

Stay as physically fit as possible. Getting out of shape has a tendency to creep up on you and the next thing you know you're 50-70 lbs overweight. That just wears out your body that much quicker and more prone to injuries. Poor eating habits, fast food diet, and permanently broken sleep cycle is what does it. Shift work is brutal on your sleep habits. Know that it will have a negative effect on your overall health. It will likely shorten your life expectancy and cut several years off the back end of your life.

Your outlook on life will change, you will become more cynical and have a jaded view if you spend any time beyond just a couple years.

Not everyone can do it. For me, it was a calling and I kind of took to it like a duck to water. I used to think a trained monkey could do it, but now I know that's not true. A lot of people find out they don't have the temperament for it and a whole lot of people don't have enough common sense to do it. You will see a lot of stupid people on the calls you run. You will go into peoples homes whose career earns them three and four times as much money as you do and are dumber than a rock. You'll constantly say to yourself and your partner, "Man, I'm in the wrong occupation!" Get used to it.

In that regard, save as much money as possible for retirement. Invest wisely and don't blow your entire paycheck. Financial security is a real and serious issue for those who work in EMS. We are adrenaline junkies and live life for today, not worrying about tomorrow because we all have an underline feeling that we could be killed tomorrow.

Have a way to relieve stress that is healty. It is an extremely high stress job. Especially at the paramedic level. There's a lot of responsibility and you work with very little, to no supervision. You're messing with peoples lives and the calls and situations patients find themselves in don't ever go like it does in a text book. You're out there at two o'clock in the morning on the interstate while you're half asleep, at a major car crash that is more like a blood bath and cars are zipping by you a foot away at 60 mph. You're trying to deal with equipment that breaks, or you can't get something to work the way you want it to, people lives are slipping away and it's pouring down rain. A moments inattention and you get hit by a semi-truck, or you aren't paying attention and something screws up and the patient ends up dying. Hopefully it's not your fault. Things just go bad and people die. If you don't have the ability to improvise on the spot, and adapt, and find a way to make things work that aren't working, you won't be suited well for this job. Will you have calls like that every week, or every couple of weeks? Well, it depends on where you work. Major urban metro areas, if it's not a call like that, it's something else equally stressful. Sometimes several times in one shift. But the stress has a cumulative effect. Again, your stress relief should be of healthy endeavors. There is a high degree of alcohol and drug abuse in EMS. Don't fall into that trap.

However, as Harry25 so aptly pointed out above, "It's a front row seat to the greatest show on earth."

In the late 70's and involved with the local sheriff's reserve, I decided to take an EMT course, it was taught by a local physician at the time. My mother was a nurse and I've always had an interest in science and medicine, I knew the EMT training would be good to have.

I'm glad I did it, though my salary always came from some other resource. I had two young kids and wife at the time, and was happy to know I stood a decent chance of giving them some life-saving measures if needed. My career path never relied on me being an EMT, but the knowledge and confidence I had were put to good use over the years.

Turn the election's in 2014 to a "2A Revolution". It will serve as a 1994 refresher not to "infringe" on our Second Amendment. We know who they are now.........SEND 'EM HOME. Our success in this will be proportional to how hard we work to make it happen.

Wow there are a lot more brothers and sisters on this forum than I thought.

As far as becoming an EMT it has been the best decision in my life, so far. It certainly takes a (mentaly) strong person, anyone can do the job really but to be good at it is a whole different story. In ten years I have worked with a lot of great and knowledgable people and some flat out terrible people, diversity is not lax in this proffession.

If there is any one thing that I have learned over the years and I try to pass on to anyone Im training it is this; learn to talk to your patients as people. This may seem pretty obvious but you would be surprised. A lot of EMS proffesionals get tunnel vision and just treat the patient (I did). Taking time to talk to them and comfort them is in my book the most important skill only after airway and bleeding managment. Since not all calls are legitimate emergencies however, the talking part is number one to me. Believe me, patients and family WILL remember you by your personality before almost anything else.

As far as everything else, you will learn a lot in the feild. It is hard to say wether or not a person will cut it without just jumping in. That being said dont be discouraged by challenges in the begining. It took me about 2 years before I really became comfortable and fully confident. Most of what you will learn in class is basics to pass the test. Just remember, 1) Scene Safety, 2) BSI, 3) ABC

In my hometown we have an all volunteer Rescue Squad. All members are EMTs of one kind or another. They respond to calls 24-7-365 no matter the weather conditions. Back in 1978 I took an EMT-A course with them and their philosophy was that they did not care if you joined the Squad or not. All they wanted was people on the street who knew exactly what to do when a medical emergency struck. I salute all those EMTs out there paid or volunteer. Without them some of us may not be here today. Thank you all.

My experience with EMT's/Paramedic's mimics what many others have said. I don't frequently work in the ER but I still run into them pretty often working as a nurse, and I must say they are often jaded, cocky, and fun as heck to be around! You will hear the funniest stories ever from an EMS crew.

Emt for 8 years its a great job some days and the worst on others. You will find yourself getting jaded and activated because of people who take advantage of the system and call for bull crape at all hours of the night. But one good call where you do help someone can make it all worth while... its long hours low pay and hard work at times up for iver 24 hours cant get to ya.. be sure you and your spouse are ready for it that's the hardest think I'm away from my wife and kids every third day all day and night every third day and at least one other night a week at my part time job also ems...think hard but if you think its for you go for it... I wouldn't trade it for anything......good luck.

Wow there are a lot more brothers and sisters on this forum than I thought.

As far as becoming an EMT it has been the best decision in my life, so far. It certainly takes a (mentaly) strong person, anyone can do the job really but to be good at it is a whole different story. In ten years I have worked with a lot of great and knowledgable people and some flat out terrible people, diversity is not lax in this proffession.

If there is any one thing that I have learned over the years and I try to pass on to anyone Im training it is this; learn to talk to your patients as people. This may seem pretty obvious but you would be surprised. A lot of EMS proffesionals get tunnel vision and just treat the patient (I did). Taking time to talk to them and comfort them is in my book the most important skill only after airway and bleeding managment. Since not all calls are legitimate emergencies however, the talking part is number one to me. Believe me, patients and family WILL remember you by your personality before almost anything else.

As far as everything else, you will learn a lot in the feild. It is hard to say wether or not a person will cut it without just jumping in. That being said dont be discouraged by challenges in the begining. It took me about 2 years before I really became comfortable and fully confident. Most of what you will learn in class is basics to pass the test. Just remember, 1) Scene Safety, 2) BSI, 3) ABC
Best of luck in your choice and endevours
Well put. There are days when you will want to walk away and I have tried but if your heart and mind are in it, you can remain strong.

Good advice and well said. Especially the part about treating patients like individual people and not a broken object.

I remember before I was in EMS I was a Respiratory Therapist. We had a young patient who decided to dive into a rock quarry. It not only broke his neck...but put him in a "vegetable state". We did ventilator care and after a couple of months he was breathing on his own. We then gave him breathing treatments with a mask as he didn't show any signs of mentally recovering. When I first started caring for him, his doctor told me to talk to him like any patient, because we really couldn't say that he didn't hear us. I always did...talking to him about weather, sports, and new movies. It was his birthday (after a few months) and I told him, "You have a beautiful day for your Birthday"...he looked out the window. I was so excited I got the nurses and doctors. He did it again and squeezed hands on command. He started coming around after that and told me he always heard me talking to him and how it gave him hope. He had a long road to recovery, but he did enough to have a productive life. I have always remembered that...no matter what the age or condition....I always talk to them....let them know what we are doing and what to expect and that they are not alone. Even when someone is dieing...they need that connection.

A woman must not depend on protection by men. A woman must learn to protect herself.
Susan B. Anthony
A armed society is a polite society. Manners are good when one has to back it up with his life.
Robert Heinlein

Good advice and well said. Especially the part about treating patients like individual people and not a broken object.

I remember before I was in EMS I was a Respiratory Therapist. We had a young patient who decided to dive into a rock quarry. It not only broke his neck...but put him in a "vegetable state". We did ventilator care and after a couple of months he was breathing on his own. We then gave him breathing treatments with a mask as he didn't show any signs of mentally recovering. When I first started caring for him, his doctor told me to talk to him like any patient, because we really couldn't say that he didn't hear us. I always did...talking to him about weather, sports, and new movies. It was his birthday (after a few months) and I told him, "You have a beautiful day for your Birthday"...he looked out the window. I was so excited I got the nurses and doctors. He did it again and squeezed hands on command. He started coming around after that and told me he always heard me talking to him and how it gave him hope. He had a long road to recovery, but he did enough to have a productive life. I have always remembered that...no matter what the age or condition....I always talk to them....let them know what we are doing and what to expect and that they are not alone. Even when someone is dieing...they need that connection.

Great story and thanks for sharing it. I always have hope that things like this will inspire future generations of healthcare providers. Pretty ironic that I am considering going back to school for respritory therapy.

I worked on a critical care ambulance for about a year. The paramedic on the crew had this rule that he is, "not here to make freinds and we do not talk to patients except to get information." Very poor bedside manners given that theory. He had been in EMS for several years. At the start of a career I can understand being nervous and taking your focus off of a person but as a seasonded veteran that atitude constitutes retirement in my opinion. I never did care for the idea of disconecting yourself from the bad either, it just leads to a bad atitude as mentiined above. The bad will come and putting it aside does not get rid of it.